Managing Single-Sided Dry Eye Due to Facial Nerve Damage
My dry eye story is a little different than most. I underwent LASIK in 2000, but experienced post-op dryness for only about six weeks, despite what I now know to be risk factors: high myope, middle-aged woman, large pupils. For the next eight years I enjoyed picture-perfect vision without even the need for an enhancement surgery, which my surgeon (fortunately I was able to see one of the top three in the nation) warned was nearly inevitable with the level of correction that I needed.
In June 2008 I underwent microvascular decompression surgery to correct for left-side hemifacial spasm. My facial nerve was injured during the surgery, resulting in facial paralysis and severe left side dry eye. I do not know how I was able to tolerate the plane ride home, but I made it somehow. After a few weeks of trial and error, I settled into a routine of applying Refresh PM ointment around the clock to keep my cornea moist. It gave me relief from dry eye pain but also blurred my vision, like looking through a lens smeared with vaseline. My brain learned to compensate, relying more on the clear vision in my right eye while utilizing the images from the left eye for depth perception.
That August, I had a 1.8 gram platinum weight implanted into my eyelid to aid in closure. It helps keep my eye shut at night, but unfortunately does not provide a complete blink.
At my September checkup, I first asked my ophthalmic surgeon about the advances in scleral lenses being made by the Boston Foundation for Sight. He dissuaded me, stating that the lens was only indicated for debilitating facial injuries such as Gulf War soldiers who had lost their eyelids altogether and had no protection for their eyes. I resigned myself to a lifetime of accepting less than optimal eyesight in exchange for keeping my cornea healthy and pain-free. But it seemed to me that a scleral lens would be ideal for a situation such as mine, so in 2011 I brought the subject up again. I think the doctor realized I would not be giving up the idea, and reluctantly granted permission to find and consult with a specialist in contacts for dry eye. He warned me that my eye might be too sensitive to be fitted successfully.
Extenuating circumstances kept me from pursuing it right away, but in 2013 I began to see an increasing number of posts on an Acoustic Neuroma Eye Issues Forum (single-sided facial paralysis with dry eye is an all-too-common side effect of surgery for acoustic neuroma as well as hemifacial spasm) concerning scleral lenses. I live in a small city, so I was not surprised to find that my local ophthalmologist did not fit scleral lenses. I contacted the manufacturer of one of the lenses mentioned on the forum and received a referral to an optometrist in a nearby city.
I emailed a brief history to the doctor and received a reply that he believed he could help me. At my initial appointment he recommended that I try Restasis twice a day for a couple of months to see if it would give me relief without needing a lens. He also recommended eyeglasses because the vision in my right eye had degraded slightly, to -1.0.
I did not do well at all with Restasis. Both of my eyes burned whenever I applied it, and I could hardly stand to wait the required fifteen minutes before I could apply drops or ointment. I did some research and discovered that Restasis was not effective for dry eye due to nerve damage, so I contacted the doctor to ask to discontinue the Restasis and proceed with a scleral lens fitting.
The first lens fit too loosely even though it looked perfect from the fitting kit. I brought it home so that I could practice inserting and removing the lens. I could only wear it an hour at a time because the lubricating drops slowly leaked out of the bottom of the lens making the lens uncomfortable and blurring my vision. The second lens had a tighter fit. If my eye doctor was 10% satisfied with the last lens, he was 80% satisfied with this one, and after wearing it for a few weeks, starting with three hours and increasing by an hour every day, we decided to stick with it.
I did not have vision insurance and could not afford a second scleral lens, so we tried several regular soft lenses on my right eye, but my cornea is so flat post-LASIK that the lenses slid and did not hold their shape. We subsequently tried a specialty soft lens to take into account my flat cornea and large pupil size, but that still didn’t work for me, so I opted to go without, resulting more or less in mono vision.
In 2014 my husband started a new job with vision insurance benefits. Instead of an out-of-pocket cost of $750 per lens, VSP would cover medically necessary lenses for both eyes for $25. My optometrist designed multifocal lenses, which made me happy because I absolutely hate the on-and-off of reading glasses.
I first heard about LaserFit lenses when inventor Dr. G commented on one of my web posts. Dr. G uses computers to precisely measure the surface of each eye to design customized non-rotational lenses. I was intrigued by the concept of computer-designed customized lenses, but at the time I could not justify the trip. It remained in the back of my mind as a possibility.
In November 2016 a number of variables fell into alignment, allowing me to schedule a LaserFit appointment. The week-long fitting process may seem excessive, but it took at least five separate appointments to get my first set of rotational scleral lenses perfected.
During the Monday appointment, Dr. G performed a comprehensive eye exam and took the digital measurements necessary to design a first set of lenses. My first pair of custom lenses arrived from the lab about 2:00 the next afternoon. For the remainder of the week, Dr. G checked visual acuity and the fit of the lenses during follow-up visits that lasted about half an hour.
The fit of the first lenses was excellent, but needed some adjustment for sharper vision. Each subsequent set of lenses improved my distance vision. By mid-week, Dr. G experimented on designing multifocal LaserFit lenses since that was what I was used to with my prior scleral lenses. Unfortunately the multifocal aspect came at the expense of distance acuity, so we reluctantly gave up on the idea. Dr. G had warned me from the outset that I would lose near vision, but I had not expected the change to be so dramatic. He suggested trying monovision (one lens designed for distance and one for near vision) but just as when I had LASIK surgery, I prefer to have both eyes corrected for distance.
Although I was relatively successful wearing standard rotational scleral lenses, I by far prefer my LaserFit lenses. Because they are designed to exactly follow the contour of my eyes, my vision is clearer and the lenses are more comfortable for a longer period of time. In addition, they do not rely on suction to stay in place and are therefore much easier to remove.
Unfortunately, VSP ended up paying hardly anything toward the lenses or the exam. This was my fault for not double-checking: between the time I first looked into LaserFit and the time that I went, Dr. G had opted out of the VSP network. I strongly urge checking with vision insurance before booking an appointment. I was fortunate to have banked enough in my HSA to cover a good chunk of the expenses. I am about to see my local optometrist to over-refract my lenses and am hopeful that insurance will cover the new pair.
I wear my LaserFit lenses up to 16 hours each day. After trying and rejecting various types of over-the-counter readers, I eventually bought glasses with progressive lenses that have no distance correction for wearing at work. At night I use drops (either TheraTears Nighttime or Refresh Celluvisc) and wear a patch over my left eye. I follow a more-or-less primal/paleo diet and am careful to drink a lot of water, both of which I feel are helpful.
Ten years have passed since I awoke from surgery to facial paralysis and dry eye. Fortunately, I have regained enough facial movement that most people don’t realize there is anything wrong, and have a workable solution for my single-sided dry eye. It is expensive and requires planning, but does not keep me from doing just about anything I want. I have been zip-lining and white water rafting in Costa Rica, hiking in England, and am going on safari in Tanzania next February.
Even though LASIK did not cause me personal long-term distress, I no longer recommend it. I was truly shocked to learn the damage the procedure can cause as well as the non-responsiveness of the industry.
Anyone interested in learning more about my dry-eye and scleral lens experience is welcome to visit my website at sarahartman.com/category/scleral-contact-lenses/